Lightweight rowers' perspectives of living with Relative Energy Deficiency in Sport (RED-S).

OBJECTIVE: To compete in lightweight rowing, strict limits are placed on the maximum body weight of each individual. As a result, lightweight rowers commonly restrict calorie intake despite high energy expenditure. This can result in Relative Energy Deficiency in Sport (RED-S). The aim of this study is to investigate the physical and psychosocial impact of RED-S, from the perspective of lightweight rowers. DESIGN: Semi-structured individual qualitative interviews. PARTICIPANTS: Adults living in the United Kingdom who are current or former lightweight rowing participants and experienced ≥1 symptom of RED-S. METHOD: Audio-recorded semi-structured individual telephone interviews were performed. Data was analysed using an inductive thematic approach, coding was iterative and data-driven, facilitated by NVivo software. RESULTS: Twelve current or former lightweight rowers (intermediate to international standard, 67% female, aged 19-32 years) participated. Participants restricted calories and increased energy expenditure to elicit weight-loss in order to meet weight requirements. This resulted in psychosocial implications (reduced social interaction, difficulty maintaining relationships, poor emotional regulation, low mood, poor concentration, disordered eating, guilt and anxiety around food, and a negative body image). Some psychosocial implications persisted after retirement from lightweight rowing. Participants described a range of physical implications, including disrupted sleep, decreased performance and recovery, bowel disruption, menstrual dysfunction, fatigue, musculoskeletal pain, injury and weakened immune systems. CONCLUSIONS: This study describes short and long-term physical and psychosocial impacts of RED-S from the perspective of lightweight rowers. Findings highlight the importance of effective RED-S prevention and management strategies for lightweight rowers. These findings may be used to educate health-care professionals, coaches and athletes on the personal impacts and serious health consequences of RED-S.

Understanding a population: A methodology for a population-based coastal safety survey.

Drowning is a global public health problem, but accurately estimating drowning risk remains a challenge. Coastal drowning comprises a significant proportion of the drowning burden in Australia and is influenced by a range of behavioural factors (e.g. risk perception, knowledge, attitudes and behaviours) that are poorly understood. These factors, along with those that impact exposure (e.g. coastal visitation and activity participation) all impact on drowning risk. While excellent mortality and morbidity data exists in Australia, a lack of coastal participation data presents challenges to identifying high-risk groups or activities and prioritising prevention efforts. This methods paper describes the development and evolution of an ongoing, annual, nationally representative online survey as an effective tool used to capture valuable data about the Australian population's relationship with the coast. This paper explores how the survey is structured (12-14 sections spanning multiple topics and themes), the different question types used (including open text, 4-digit responses and categorical questions), the sample size (1400-1600 respondents), sampling strategy (using demographic quota sampling which can then be post-weighted to the population if required) and how topics and themes have changed over time to enhance the quality of data collected (i.e., wording changes to enhance participant comprehension or data usability and changing issue-specific 'feature' topics of interest such as campaign evaluation). How the survey is implemented online is described, both practically through to third-party recruitment processes and ethically to maximise anonymity of respondents and ensure data quality. Interim analyses indicate the impact of considering exposure when calculating fatal drowning rates, especially by activity (e.g., crude boating drowning rate 0.12 per 100,000 population vs 0.95 per 100,000 exposed population [relative risk = 8.01; 95% confidence interval: 4.55-14.10]). This study highlights lessons learned in the process of conducting a nationally representative coastal participation survey as well as the strengths and limitations of adopting this approach. Data collected will provide more detailed information on the skills, behaviours, knowledge and attitudes of coastal activity participants. Analyses of this unique dataset will inform research that will underpin development and evaluation of coastal drowning prevention initiatives prioritising those most at risk. It is hoped that the methods detailed within this study may be useful for other countries to develop similar approaches to understanding their own population.

Pacing strategies and relationships between speed and stroke parameters for elite sprint kayakers in single boats.

The study aimed to determine the pacing strategies of elite single-boat sprint kayakers, as well as the relationships between stroke parameters (stroke rate (SR) and stroke length (SL)) and kayak speed throughout the race. High-resolution split speed and stroke parameter data from men's (MK1) and women's (WK1) single-boat A- and B-finals in 2016-2017 international sprint kayak competitions were analysed. Correlation coefficients were calculated between SR-speed and SL-speed during each split for each race group. Athletes followed all-out, positive and seahorse-shaped pacing strategies for the 200 m, 500 m and 1000 m races, respectively. SL-speed had greater correlations during the first half of the MK1 200 m race, whereas SR-speed had greater correlations during the second half. SR-speed correlations were greater than SL-speed correlations throughout the final 150 m of WK1 200 m races. There were large and very large correlations between SR-speed at the end of both the WK1 500 m and MK1 1000 m race distances, respectively, despite following different pacing strategies. Single-boat pacing strategies change due to race distance during major international sprint kayak competitions, whereas the relationships between stroke parameters and speed change depending on athlete sex and the race distance.

I Want to Row Across the Atlantic. But You Have Amyotrophic Lateral Sclerosis!

ABSTRACT: We describe an individual with slowly progressive amyotrophic lateral sclerosis who decided to enter the Talisker Whisky Atlantic Challenge, a rowing event across the Atlantic Ocean, and completes it in 51 days in a 5-man boat.

Neural correlates underpinning synchronized movement of double scull rowers.

We investigated the neural correlates underpinning synchronized movement in rowers using a neural index for social interaction termed the phi complex. Phi 1 and phi 2 indicate the enhancement and reduction of mirror neuron activation, respectively. We hypothesized that in a leader-follower relation, followers would exhibit a larger phi 2 power than leaders due to enhanced mirror neuron activation by the followers to accurately mimic their partner's movements. We also expected that brain activation underlying social interaction would be enhanced during synchronization. Although phi 2 was not modulated by role (leader vs. follower) or condition (usual-pair vs. unusual-pair), the statistical analysis suggested the relationship between the magnitude of phi 2 and empathetic ability in followers in the usual-pair condition. Given that the activation of the mirror neuron system underlies empathic ability, it is plausible that the participants used the mirror neuron system to follow the movement of a usual partner. In other words, the leader in the synchronization did not need to use the mirror neuron system, which was consistent with the result of a larger phi 1 for leading than following the movement. These results suggest that the neural correlates of empathy may be used to synchronize with partners as the follower.

'You're the best liar in the world': a grounded theory study of rowing athletes' experience of low back pain.

OBJECTIVES: Low back pain (LBP) is common in rowers and leads to considerable disability and even retirement. The athlete voice can help clinicians to better understand sport-related pain disorders. We aimed to capture the lived experience of LBP in rowers. METHODS: Cross-sectional qualitative study using a grounded theory approach. Adult competitive rowers with a rowing-related LBP history were recruited in Australia and Ireland. Data were collected through interviews that explored: context around the time of onset of their LBP and their subsequent journey, experiences of management/treatment, perspectives around present beliefs, fears, barriers and expectations for the future. RESULTS: The 25 rowers (12 women/13 men) who participated were aged 18-50 years; they had a mean 12.1 years of rowing experience. They discussed a culture of concealment of pain from coaches and teammates, and fear of being judged as 'weak' because of the limitations caused by LBP. They reported fear and isolation as a result of their pain. They felt that the culture within rowing supported this. They reported inconsistent messages regarding management from medical staff. Some rowers reported being in a system where openness was encouraged-they regarded this a leading to better outcomes and influencing their LBP experience. CONCLUSIONS: Rowers' lived experience of LBP was influenced by a pervasive culture of secrecy around symptoms. Rowers and support staff should be educated regarding the benefits of early disclosure and rowers should be supported to do so without judgement.

Similarities and differences between sports subserving systematic talent transfer and development: The case of paddle sports.

OBJECTIVES: The aim of this study was to investigate similarities and differences for 18 sports toward canoe/kayak in order to identify donorsport and/or multisports, based upon a systematic analysis of the task constraints per sport that are assumed to be either crucial or less important from the coaches' viewpoint. DESIGN: Descriptive survey analysis. METHODS: 891 certified coaches from 19 sports valued (0-10; not important at all-very important) 15 characteristics by a questionnaire (Flemish Sports Compass) within their sport. Unique sport-profiles (discriminant analysis - DA) were constructed for 19 sports based on these characteristics. Similarities and differences between canoe/kayak and the other 18 sports were analyzed by means of MANOVAs on anthropometric, physical and motor coordination characteristics. RESULTS: Cross validated DA (rcan=0.660, Wilks' Lambda=0.564, p<0.001) showed that 72.1% of the canoe/kayak coaches were correctly assigned to their sport. For canoe/kayak seven characteristics were valued crucial; dynamic balance (8.51±1.69), core stability (8.45±2.27), pulling power (8.12±1.68), speed (7.54±2.07), endurance (7.27±2.03), stature (6.43±1.41) and rhythm (6.01±3.01). Least important characteristics were: flexibility (6.16±1.75), agility (4.27±3.10), catching (3.90±3.22), climbing (2.45±3.05), jumping (1.81±2.11), throwing (1.60±2.24), hitting (.94±1.77) and kicking (.61±1.04). CONCLUSIONS: This novel approach to determine important characteristics per sport makes identifying similarities and differences between sports possible. Similarities might enlarge talent-pools for possible talent transfers. Differences can help identify sports based on complementary characteristics for the construction of broad motor development programs. From this viewpoint gymnastics can serve as potential donorsport (similarities) for canoe/kayak, while handball and tennis can subserve broad development for young canoe/kayak athletes.

A brief literature review of the psychological benefits of volunteerism in watersports inclusion.

The 2009 National Guidelines on Physical Activity for Ireland assert that 'all people with disabilities should be active'. Events such as the Watersports Inclusion Games invite individuals across the full spectrum of abilities to take part in physical activity in the form of adaptive watersports. This literature review aims to assess the value of inclusive watersport events such as this in the context of what is currently published on the motivation and benefits for volunteers in watersports inclusion. This is the first review that we are aware of on this subject. A literature review was performed using the Population, Exposures and Outcomes framework. Medical and psychological databases, journals and grey literature were searched using keywords, and articles were selected according to their relevance to the question. References from these articles were then hand-searched. The outcomes of this review suggest that, while there are many papers published on the benefits for volunteers in general and in sport, there is a relative paucity of literature on volunteers in inclusive sport, and even less relating to inclusive watersports. This review identifies a powerful opportunity to provide evidence to support the benefits of inclusive watersport for both participants and volunteers. Further research is required on why volunteers become involved in inclusive watersports and the benefits they derive from their involvement.

A repeated-measures examination of organizational stressors, perceived psychological and physical health, and perceived performance in semi-elite athletes.

Organizational stressors can undermine the psychological well-being and performance of athletes. Less is known, however, about how these relationships unfold over time and whether organizational stressors can impact upon perceived physical health. The current study, therefore, used a repeated-measures design to examine relationships between organizational stressors with components of perceived psychological (anxiety and depression) and physical (illness symptoms and missed training days via illness) ill-health, and perceived performance at the within-person level. Twenty-three semi-elite female rowers completed monthly measures of study variables for six-months. Multilevel models indicated that selection-related stressors positively predicted symptoms of perceived psychological and physical ill-health, and negatively predicted perceived performance. Conversely, coaching stressors negatively predicted symptoms of perceived psychological ill-health. Logistics and operations stressors positively predicted perceived performance, whereas goals and development stressors negatively predicted perceived performance. These findings demonstrate for the first time that, with a repeated-measures design, organizational stressors can predict components of perceived physical and psychological ill-health, and perceived performance at the within-person level in athletes. From a practical perspective, practitioners should incorporate these findings when diagnosing the need for, developing, and optimally implementing primary and secondary stress management interventions.

Evolución de la competencia en el agua de los socorristas acuáticos / Evolution of the Competence in Water of the Aquatic Lifeguards

En el año 2006 entró en vigor la normativa que actualmente regula la formación de socorristas en la Comunidad Autónoma de Madrid (España). El objetivo de este estudio es conocer la influencia de la aplicación de esta normativa sobre el porcentaje de aspirantes que obtiene el diploma de socorrista acuático y sobre su nivel de competencia en el agua. Para ello, se han analizado las marcas de tiempo acreditadas por 6.105 aspirantes a socorrista (4.288 hombres y 1.817 mujeres) que se formaron entre los años 1993 y 2016. Los resultados demuestran que, desde la entrada en vigor de dicha normativa, se ha incrementado el porcentaje de aspirantes que obtiene el diploma de socorrista acuático, pero se ha disminuido su nivel de competencia en el agua. Se recomienda que las instituciones competentes establezcan objetivos y criterios de evaluación que promuevan la mejora del nivel de competencia en el agua de estos profesionales

In 2006, the normative that currently regulates the training of lifeguards in the Autonomous Community of Madrid (Spain) came into force. The objective of this study is to know the influence of the application of this regulation on the percentage of applicants who obtain the aquatic lifeguard diploma and on their level of competence in the water. For this purpose, the time marks, accredited by 6,105 applicants to lifeguards (4,288 men and 1,817 women) who received this training between 1993 and 2016, have been analysed. The results show that, since the regulation came into force, the percentage of applicants who obtain the lifeguard diploma has increased, but their level of competence in the water has decreased. Therefore, it is recommended that objectives and assessment criteria that are established by the institutions, encourage the improvement of the level of competence in the water of these professionals

A demographic test of accidental versus intentional island colonization by Pleistocene humans.

This study evaluates the hypothesis that some documented cases of long-distance sea crossing by the Late Pleistocene Homo sapiens occurred as a result of accidental drifting, rather than by intentional seafaring. For that purpose, we use an existing computer simulation framework, with some modifications, to investigate the likelihood that a planned or unplanned island colonization by a small group of individuals will persist to establish a viable population. Within the original framework, planned colonization was operationally characterized as being initiated by equal numbers of unrelated young men and women, whereas for unplanned colonization, those who migrate inadvertently were regarded in effect as a random sample of the whole population. Here, we consider a different scenario for unplanned colonization, which we believe is more relevant to sea crossing by the Late Pleistocene humans, that is, we assume that unplanned colonization occurs when members of households on watercrafts with limited voyaging capabilities are drifted away by ocean currents and washed up on a distant island. We also extend the previous analysis by considering a broader range of combinations of fertility and mortality schedules that individuals are assumed to follow. Our simulations suggest the following: (1) colonization of an island by ten or fewer unrelated young men and women can be successful within the feasible range of fertility and mortality levels; (2) in comparison, the likelihood of success for unplanned colonization is considerably smaller for the same range of fertility and mortality levels; and (3) there exists a small range of parameter combinations for which unplanned colonization has a non-negligible prospect of success even without assuming recurrent accidental drifts to the same island, and thus, the accidental colonization scenario cannot be totally excluded. In addition, we find that the minimum founding population required for successful colonization varies substantially depending on the fertility and mortality levels.

Exploring Health Demographics of Female Collegiate Rowers.

CONTEXT: Limited information exists about health patterns among female rowers at the collegiate level. Furthermore, the element of weight class (lightweights classified as <130 lb [59 kg]) as a factor in the physical and mental health of female collegiate athletes has not been investigated, despite weight requirements in sport being a risk factor for the female athlete triad. OBJECTIVE: To test the hypotheses that (1) components of the female athlete triad were more prevalent in lightweight than in openweight rowers; (2) perceived stress levels were greater in lightweight than in openweight rowers; and (3) rowers who were unable to row due to injury had greater perceived stress levels than uninjured athletes. DESIGN: Cross-sectional study. SETTING: Twelve collegiate women's rowing programs consisting of 6 National Collegiate Athletic Association Division I openweight and 6 Intercollegiate Rowing Association-level lightweight teams. PATIENTS OR OTHER PARTICIPANTS: A total of 158 female collegiate rowers (78 lightweight, 80 openweight). MAIN OUTCOME MEASURE(S): An electronic survey addressing injury history, diet and eating habits and body image (according to the triad screening questionnaire), stress levels (Perceived Stress Scale), and athlete identity (Athlete Identity Measurement Scale) was administered. RESULTS: Lightweight rowers reported limiting or carefully controlling foods more frequently than openweight rowers (41.9% to 29.9%, P = .013). A history of an eating disorder was more prevalent among lightweight than openweight rowers (25.7% to 13.0%, P = .048). Prevalences of stress fractures and menstrual irregularities did not differ between weight classes. Lightweight and openweight rowers' scores on the Perceived Stress Scale (16.0 ± 9.9 and 17.3 ± 6.4, respectively) were not different. Injured rowers scored higher on the Perceived Stress Scale (19.4 ± 7.2) than did uninjured rowers (16.6 ± 5.72). CONCLUSIONS: Weight class did not contribute to differences in the prevalence of female athlete triad components or perceived stress, although lightweight rowers were more likely to have a history of eating disorder. Injury may be a risk factor for increased stress in this population.

The Physical and Psychological Experience of Rowing the North Atlantic Solo and Unassisted.

INTRODUCTION: The present study followed an individual's successful, record-setting, solo, unsupported row across the North Atlantic Ocean to gain an understanding of the physical and psychological experience of this extreme endurance feat. METHODS: The participant was a 37-y-old male endurance athlete. Over the course of his nearly 39-d row, he provided daily ratings of effort, physical symptoms, and psychological experiences via a self-report questionnaire. Quantitative data were analyzed using simulation modelling analysis to examine within-day and cross-lagged correlations between perceived exertion and all other variables. Qualitative data were examined via thematic content analysis. RESULTS: Results showed that, on average, the participant experienced low levels of pain intensity, pain interference, fatigue interference, sleepiness, loneliness, boredom, anxiety, and frustration, in contrast to moderate scores for fatigue, restfulness, positive emotions, calmness, and confidence. There were statistically significant correlations between higher levels of perceived exertion and higher same-day levels of pain interference, fatigue, and fatigue interference, as well as lower same-day levels of calmness, loneliness, and boredom. Qualitative responses revealed 3 primary stressor types (internal physical, internal psychological, and external stressors) and 5 coping responses (acceptance/mindfulness, active response/problem solving, adjusting expectations/goal setting, distraction, and resignation). CONCLUSIONS: Study findings indicate that the extreme athlete experienced physical and emotional challenges, but he demonstrated positive adjustment via the frequent experience of positive emotions and proficient use of a broad set of coping strategies matched to the daily stressor being addressed.

Improvement of quality of life in adolescents with epilepsy after an empowerment and sailing experience.

PURPOSE: Epilepsy in adolescents affects their psychological health, independence, and emotional adjustment. Psychological and self-management interventions might give benefits to adolescent with epilepsy in terms of quality of life, emotional well-being, and reduced fatigue. "Fondazione Tender To Nave Italia" promotes a project using sailing activities as an empowerment opportunity. The main aim of our study was to examine the empowerment effects on quality of life of adolescents with epilepsy attending sailing activities, and to compare the results perceived by adolescents and their parents. METHODS: Fifty-eight patients with a diagnosis of epilepsy were included in an empowerment project titled "Waves rather than spikes" from June 2013 to July 2018. Intellectual level was based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria. Patients were administered Pediatric Quality of Life Inventory (PedsQL), adolescent and parent version. Behavioral data were collected by parent-report Child Behavior Checklist (CBCL). RESULTS: Thirty female and 28 male patients with a mean age of 15 years, referred to "Bambino Gesù Children's Hospital" in Italy, were included. Thirty-three (56.9%) patients had a history of refractory epilepsy; 34 (56.2%) received polytherapy, 19 (32.7%) monotherapy, and 5 (8.6%) were not taking antiepileptic drugs. Intellectual functioning was normal in 43 (74.1%), borderline in 9 (15.5%), and mildly impaired in 6 (10.3%). Results from PedsQL adolescent report revealed significant postintervention improvement for total score (p = 0.023) and in two domains: physical health (p = 0.0066) and emotional functioning (p = 0.015). Results from PedsQL parent report showed significant postintervention improvement for the domain of school functioning (p = 0.023). In the multivariate model, a low CBCL value was predicting a higher score in the health subscore difference between pre- and postempowerment activity (p = 000.8). CONCLUSION: Empowerments activities are crucial in order to reduce the burden of epilepsy in adolescents, and to improve quality of life. These are critical factors for a well-managed transition phase to adulthood.

"One stroke, with twenty-two people": exploring prostate cancer survivors' participation in dragon boating.

Purpose: This study qualitatively explores prostate cancer survivors' experience in joining a dragon boating team and its possible impact on their wellbeing.Design: Qualitative data analysis.Sample: Eleven prostate cancer survivors from a dragon boat team.Methods: Semi-structured interviews and thematic analysis.Findings: The findings support physical benefits of dragon boating, however, the positive impact on the men's psychosocial wellbeing was more salient. Participation in dragon boating was important for establishing a social support system and positively reframing their cancer experience.Practice Implications: Dragon boating is a novel health promotion strategy for men with PC. Seeking to replicate the positive characteristics of dragon boating in the design of future physical activity interventions should be explored.

Sound matters: The impact of auditory deprivation on movement precision in rowing.

Purpose of the study was to quantify the importance of auditory feedback for movement precision in elevated rowing task difficulty with elite athletes under normal and masked hearing conditions. It was hypothesized that rowing with masked hearing would reduce the precision of movement, particularly at the non-usual/less-preferred stroke frequencies (SF). Self-reported questionnaires helped to understand the difficulty of the task. Twenty rowers completed 2 × 1000 m-distance-blocks, each separated into 4 × 250 m, with increasing SF 18, 20, 22 24 strokes/minute once with normal and once with masked hearing. Precision was determined as the deviation between the SF target and the SF actually performed (DSF). Athletes' subjective perception was requested before and after the experiment. A 2 (hearing condition) × 4 (SF 18, 20, 22, 24) repeated measures ANOVA showed systematically larger DSF during masked hearing for all SFs compared to the DSF in the normal hearing condition (p < .01). Further, the highest DSFs were found for SF 18 and 24 in both hearing conditions (no interaction effect). The athletes' perception of the relevance of natural movement sounds for their rowing performance changed when evaluated before and after the experiment. Rowing without hearing was evaluated as mentally more demanding than physically. The results confirmed our initial assumptions and showed the relevance of natural auditory information for movement precision in rowing practice, even at a high level of expertise.

Lets go surfing now, everybody's learning how; attentional strategies on expert and novice surfing performance under both practice and competition conditions.

Research suggests an external focus of attention (EFOA) promotes effective performance and learning compared to an internal focus of attention (IFOA), with explanations proposed by the constrained action hypothesis (CAH) and OPTIMAL theory of motor learning. Specifically, it is proposed that adopting an EFOA prevents the constraining of normally automatic control processes and subsequent performance decrements (typically observed when individuals adopt an IFOA) by simultaneously reducing self-focus strategies and enhancing goal-action coupling. The present study attempted to fill this research lacuna by examining the CAH and OPTIMAL theory in a complex, ecologically valid, motor task under both low and high-pressured conditions. In two separate experiments, novice (n = 23) and advanced (n = 21) surfers completed a surfing task in an artificial Wavegarden under either EFOA or IFOA instructions. Experimental phases included a pre-test, acquisition and competition transfer. Results revealed that advanced and novice surfing performance benefited from adopting an EFOA in both normal and competitive situations. These findings are discussed in terms of the theoretical implications for the CAH and OPTIMAL theory, in addition to the anxiety literature. Reference to applied implications when instructing and performing within ecologically valid surfing settings are also presented.

Athletes Play Through Pain-What Does That Mean for Rehabilitation Specialists?

CONTEXT: Pain in sport has been normalized to the point where athletes are expected to ignore pain and remain in the game despite the possible detrimental consequences associated with playing through pain. While rehabilitation specialists may not have an influence on an athlete's competitive nature or the culture of risk they operate in, understanding the consequences of those factors on an athlete's physical well-being is definitely in their area of responsibility. OBJECTIVE: To explore the factors associated with the experiences of subelite athletes who play through pain in gymnastics, rowing, and speed skating. DESIGN: The authors conducted semistructured interviews with subelite athletes, coaches, and rehabilitation specialists. They recruited coach participants through their provincial sport organization. Athletes of the recruited coaches who were recovering from a musculoskeletal injury and training for a major competition were then recruited. They also recruited rehabilitation specialists who were known to treat subelite athletes independently by e-mail. SETTING: An observation session was conducted at the athlete's training facility. Interviews were then conducted either in a room at the university or at a preferred sound-attenuated location suggested by the participant. PARTICIPANTS: The authors studied 5 coaches, 4 subelite athletes, and 3 rehabilitation specialists. INTERVENTIONS: The authors photographed athletes during a practice shortly before an important competition, and we interviewed all the participants after that competition. Our photographs were used during the interview to stimulate discussion. RESULTS: The participant interviews revealed 3 main themes related to playing through pain. They are: Listening to your body, Decision making, and Who decides. CONCLUSION: When subelite athletes, striving to be the best in their sport continue to train with the pain of an injury, performance is affected in the short-term and long-term consequences are also possible. Our study provides some insight into the contrasting forces that athletes balance as they decide to continue or to stop.